Provider Demographics
NPI:1851902837
Name:SPAVOR, ALYSSA BREANNE (RPH)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:BREANNE
Last Name:SPAVOR
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10328 W ROBIN LN
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-2690
Mailing Address - Country:US
Mailing Address - Phone:623-227-7891
Mailing Address - Fax:
Practice Address - Street 1:7448 W THUNDERBIRD RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-6069
Practice Address - Country:US
Practice Address - Phone:623-979-0558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS024762183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist